Published online May 15, 2020. doi: 10.4251/wjgo.v12.i5.549
Peer-review started: February 3, 2020
First decision: February 25, 2020
Revised: April 14, 2020
Accepted: April 24, 2020
Article in press: April 24, 2020
Published online: May 15, 2020
Neutropenia after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) treatment of colorectal cancer with peritoneal metastases is poorly studied.
Neutropenia is currently a treatment limiting toxicity in HIPEC. Its association with the combination treatment of oxaliplatin and irinotecan HIPEC caused this intensified HIPEC regimen to be stopped. However, the implications of the neutropenia was never investigated as it was assumed to be an unwanted side-effect. More research in neutropenia is needed if more intense HIPEC treatment are to be investigated.
The objective of this study was to report on the frequency of neutropenia and its effect on Clavien-Dindo morbidity, reoperation rate, disease-free and overall survival.
An observational cohort study design was implemented using two prospectively maintained databases – Uppsala and Sydney. Kaplan-Meier and log rank tests were used as well as Cox proportional hazard models.
Neutropenia occurs in 13% of colorectal cancer patients being treated with HIPEC and is more common in the oxaliplatin + irinotecan HIPEC regimen. Neutropenia is not associated with increased Clavien-Dindo morbidity nor increased reoperation rate. It is a positive prognostic factor for disease-free survival with a clear benefit in disease-free survival (P = 0.02) as well as a trend towards a benefit in overall survival (P = 0.07).
Neutropenia may not be a treatment limiting toxicity. HIPEC intensification is possible without increasing morbidity or the reoperation rate. Unexpectedly, neutropenia was a positive prognostic factor for disease-free survival. Future studies need to confirm this unexpected finding. It suggests that neutropenia should be viewed with a different perspective – not as an unwelcomed complication, but rather as a possible predictor of treatment efficacy.